This is the implication of a guest editorial in the British Journal of Psychiatry by Hollingdale, Woodhouse and Deeley (2026). But these authors are all involved in private diagnostic assessments, some of which are for the Courts, unsurprisingly their conclusions are therefore expressed more ‘measuredly’.
The elaborated shortcomings of the Autism assessment process could be applied to the spectrum of disorders under NHS England’s mental health umbrella:
‘there is considerable variation in the quality of assessments and associated reports within and between NHS services and private practice.9 For example, to reduce costs, some services may undertake only a brief autism-specific developmental history or use non-standardised, non-validated online observations. They may also employ less experienced professionals to administer complex assessment tools. Such clinicians may have less clinical experience and may not be trained in differential diagnosis. Other factors that may contribute to variation in diagnostic decisions include inconsistent determination of impairment as a component of diagnosis, perceived pressure to provide a diagnosis when individuals or families are paying high fees for assessments and differences in the weight given to self-report or family report compared with observable features required for a diagnosis’
‘Following assessment, comprehensive formulations and reports are recommended to inform support needs. However, to reduce time and associated costs, diagnostic letters with non-individualised recommendations may be provided as an alternative. Robust individual formulations are essential not only for those diagnosed with autism but also for those who do not meet diagnostic criteria, as subthreshold autistic characteristics or alternative diagnoses may be more relevant to their current or future mental health and adaptive functioning. Ultimately, given recent changes to assessment methods in response to increasing demand, the clinical quality of many autism assessments may be at risk’
They conclude:
‘This emphasises the importance of ensuring that comprehensive and robust assessments, including a suitable screening and triage process, are conducted by suitably trained, qualified and experienced professionals. Adequate time should be allocated to ensure that comprehensive reports are produced, differential diagnoses are considered and bespoke care plans are developed. While recommendations and guidelines exist, quality control procedures could be introduced to prevent future harm to individuals and negative implications for services’.
There is a desperate need for a re-think across the spectrum of disorders Not to do this is as calamitous as ignoring climate change.
Dr Mike Scott